De-freezing frozen patient management. (17th January 2017)

• Record Type: Journal Article
• Authors: Kobo-Greenhut, Ayala; SHNIFI, AMIN; TAL-OR, ERAN; MAGNEZI, RACHELI; NOTEA, AMOS; RUACH, MEIR; ONN, EREZ; COHEN, AYALA; DOVEH, ETTI; Ben Shlomo, Izhar; Hasin, Yonatan
• Is Part Of: International journal for quality in health care. Volume 29:Number 2(2017)
• Page Start: 206
• Page End: 212
• Publication Date: 2017-01-17
• Subjects: quality management -- quality improvement < quality management; Medical care -- Quality control -- Periodicals; 362.1068
• DOI: 10.1093/intqhc/mzw156
• Languages: English
• ISSNs: 1353-4505

Abstract

Abstract: Objective: To compare the effectiveness of two methods in encouraging the consideration of a leap from one patient management routine to another: (i) real-time review of the facts by an external medical team (ii) implementation of the &#39;re-thinking-protocol&#39; (&#39;de-Freezing&#39;) by both treating and external medical teams. Design: Students accompanied doctors, nurses and patients as non-interrupting observers. When an obvious gap between the expected and actual findings occurred, it was discussed four times: by two teams (treating team, external medical team) in two discussion modes (real-time review, de-Freezing-questionnaire). The students then recorded if a leap was considered for each discussion. Setting: The study was conducted in the emergency department of the Baruch Padeh Medical Centre, Poriya, Israel. Participants: All patients were included during times when both medical teams (treating, external) were present. Intervention(s): During 14 periods of 5–7 h each, 459 patients were sampled. In 183 patients, 200 gaps were discovered. Results: The external team considered a leap 76 times, compared with 47 by the treating team ( P &lt; 0.001). Using the de-Freezing-protocol, the treating team considered a leap 133 times. Interestingly, even the external team benefited from the de-Freezing protocol and considered a leap 140 times (NS compared to the treating team). Conclusions: While the importance of timely leaping from one patient management routine to another is emphasized in the training of physicians, medical teams too often fail to do so. The de-Freezing-protocol inexpensively encourages the consideration of a leap beyond what is evoked by the involvement of an external team. The protocol is applicable to all medical processes and should be incorporated into medical practice and education.